Determining pain’s origin – is it the hip, spine or both?

Many people live with low back pain that radiates to the buttock, groin, thigh, and even knees. The challenge for patients, and often their doctors, is determining the origin of the pain—the hip, the spine or both. A new article published in the February Journal of the American Academy of Orthopaedic Surgeons (JAAOS) outlines the identical symptoms associated with hip and spine pain and discusses the diagnostic steps and tests required to treat them appropriately.

Typically, groin pain, and/or difficulty putting on shoes or getting in and out of a car, are associated with a hip condition. Buttock or back pain, with or without a tingling sensation, most likely originates in the spine. However, patients with complex “hip-spine syndrome” have lower back and hip pain with no clear source of the discomfort. Hip arthritis, for example, can increase pressure on the lower back.

“In these instances, similar or overlapping symptoms may delay a correct diagnosis and appropriate treatment,” said author Afshin Razi, an orthopaedic surgeon and clinical assistant professor at NYU Langone Hospital for Joint Diseases.

The article recommends that patients provide a detailed health history and undergo a comprehensive physical examination that includes an assessment of gait (how the patient walks); hip and back range of motion; posture; pelvic, lower limb, and spinal alignment; loss of muscle (atrophy); previous surgical scars; and limb-length discrepancy.

“Plain and advanced imaging studies and diagnostic injections also can be used to further delineate the primary problem and guide the appropriate sequence of treatment,” said Razi.

Diagnoses for hip and spine pain can include hip osteoarthritis, a stress fracture, osteonecrosis of the hip (a blockage in blood flow to the hip), a labral tear (damage to the cartilage that surrounds the hip), disc herniation and possible pinched nerves, stenosis (narrowed spinal canal causing nerve pain), sacroiliac joint dysfunction in the spine, and other less common sources of pain.

“Focusing on both the spine and the hip as potential causes of pain and disability may reduce the likelihood of misdiagnosis, and the management of conditions affecting the spine and/or hip may help reduce the likelihood of persistent symptoms,” said Razi.